Assisted reproduction is a dynamic field of science which evolves and reshapes itself almost on a daily basis. Assisted reproduction, in its simplistic definition, refers to achieving pregnancy with some help from science. The help from science does not necessarily involve using high-tech equipment and alien technology! In most cases, assisted reproduction is a mere replication of the natural biological and physiological processes of the human body based on our current knowledge and understanding of it. Through research and clinical studies, we continuously improve our knowledge and awareness of the natural biological and physiological processes of the human body, which helps us design better treatment regimens for our patients when preparing them for pregnancy. In other words, the more we understand how our bodies work at the cellular level, the more we can assist them when they need a helping hand.

Platelets, which are also known as thrombocytes, are a part of our blood involved in wound healing and tissue regeneration. The role of platelets is to recognize the site of injury (interrupted endothelium), adhere to the site of injury and secrete chemical messengers, activating the wound healing process. Platelet-rich plasma (abbreviated as PRP) is the blood product where we obtain the blood sample of an individual and use laboratory techniques to separate the platelet rich part of blood from the part that is platelet poor. This allows us to obtain high concentrations of platelets in small amounts of blood plasma. The purpose of obtaining platelet rich plasma is to magnify and multiply its natural healing effects on damaged tissues in relatively short periods of time when natural quantities fail short of this task.​PRP is a relatively new and highly promising regenerative therapeutic application which can offer several therapeutic benefits without detrimental side effects as it is a direct product of own blood sample. PRP is highly rich in several growth factors that have a significant role in tissue regeneration. The main ones include epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), transforming growth factor beta 1 (TGF-B1), transforming growth factor beta 2 (TGF-B2), several classes of platelet-derived growth factors (PDGF), insulin like growth factor (IGF-1) and hepatocyte growth factor (HGF). These growth factors work in a collective manner in key parts of tissue regeneration such as cell growth, proliferation and differentiation in addition to improved oxygen delivery and circulation. While PRP helps with tissue regeneration via employment of growth factors, it also has the ability to do so without causing an inflammatory response through its anti-inflammatory molecules such as hepatocyte growth factor.

PRP is now currently being used for a variety of purposes including dermatological applications such as anti-aging, hair re-growth, dental applications, as well soft tissue regeneration. More recently, clinical trials and animal testing have provided substantial amount of evidence that PRP can have many beneficial effects in the field of infertility through its regenerative effects.

The idea is not far fetched when you think about the every day injuries we suffer in our daily lives – We can fall and bruise, cut ourselves while dicing a tomato. When we end up having an open wound, eventually, inflammatory action is initiated and by our immune system and the wound becomes inflamed with some edema. As healing continues, a yellowish layer is formed over the wound. This layer is a combination of white blood cells (leukocytes), blood clots, platelets, and several growth factors at work, preventing bleeding, infection, and regenerating connective tissue and repairing the damage in the area. Using the same principle, injection of these growth factors into any part of the body essentially provides rejuvenation and cellular regeneration.

Endometrial Application of PRPChronic endometritis and endometriosis are problems that can inititate inflammatory processes, which can make embryo implantation very difficult either through natural intercourse or in vitro fertilization (IVF). In recent animal testing, PRP applications have been demonstrated to have cell proliferative effects as well as anti-inflammatory effects while working on tissue repair. PRP application has also been associated with increased progesterone receptor activity. Progesterone receptors are the main actors that help maintain a thick and healthy endometrial lining, which in turn, helps with embryo implantation.

Human studies are also offering identical outcomes. While the studies are still in their preliminary stages, commercial application has started due to potential benefits and the lack of detrimental biological side effects based on performed studies. At North Cyprus IVF Center, we have now started offering PRP applications for patients with chronic endometritis, patients with recurrent implantation and IVF failures as well as patients who cannot obtain a desired level of endometrial thickness for a successful embryo transfer.The endometrial PRP application is administered 2 to 4 days prior to embryo transfer as the cellular activity reach their optimal levels within this time frame. The cost of endometrial PRP application during an IVF cycle is 500 Euros.

Ovarian PRP Application: Ovarian Rejuvenation

One of the most frequently asked questions is whether or not menopause can be reversed. Our knowledge on the subject so far has told us no. Every woman is born with a finite set of ovarian reserves and these reserves decline over time with each menstrual cycle. However, recent advances in research and clinical studies is pointing to the possibility of regenerating ovarian function even after menopause. According to latest research by Harvard scientists, PRP application in the ovarian cortex can possibly stimulate the germ cell line into developing into ovarian oocytes. Scientists have achieved success with animal testing and observed that injection of growth factors enabled resurgence of oocyte production in the ovaries.

PRP application in ovarian soft tissue aims at cellular growth and proliferation in the ovaries. While the clinical evidence is still in its preliminary stages and the ovarian PRP application is still a very new practice, the existing evidence points to incredible outcomes in patients even in menopausal stages. While the experience with this application is still limited and it is still too soon to promise pregnancy to women who have entered menopause, PRP application does have some proven effects.

So far, the only published scientific documents has studied the effects of ovarian PRP infusion on 8 peri-menopausal women. According to the results of this study, following an ovarian PRP infusion, return of ovarian function was observed within three months. Based on our own experience at North Cyprus IVF Center with PRP infusion, again, with a limited number of women, we have seen increased ovarian function/activity in a great majority of women who received ovarian PRP infusion.

Based on the known and predicatable endothelial and vascular growth factor activity, increased vascularization and improved blood supply are the expected benefits of a PRP application. However, growth factors in platelets can also stimulate activation of the stem cells present in the ovaries, that have the potential to mature into oocytes. While this is an observed effect, it is not known how long folliculogenesis can be maintained and if the quality of oocytes would allow for a successful healthy pregnancy in women who have already entered menopause. There is now evidence to suggest occurence of one such pregnancy at the age of 49 after PRP infusion.​While PRP application is a natural way of tissue regeneration and rejuvenation, we can only rely on scientific evidence. Collection of large scale data of ovarian rejuvenation and pregnancy outcomes will requir treatment of hundreds of women before a conclusion can be drawn. We expect to have more concrete statistics by the beginning of 2018.

How Much​ Does Ovarian PRP Application Cost?

The cost of ovarian rejuvenation via PRP application is 1,500 Euros at North Cyprus IVF Center for both ovaries. The total cost of 1,500 Euros includes the pre-operative blood work (CBC) and the infectious disease screening panel including VDRL, HbsAg, HCV, HIV testing. Therefore, there are no surprises or hidden costs during your visit to our hospital. Our patient coordinators can also help organize your hotel booking during your stay in Cyprus. You will be expected to stay for a minimum of one, preferably two nights in Cyprus.

Are There Any Risks of Ovarian Rejuvenation with PRP?

The PRP injection itself is practically risk free as the process involves injecting the ovaries with your own blood product. There are no artificial chemicals or other potentially harmful substances introduced into your body. However, the way of administration requires sedation, just like you would be sedated in an IVF cycle during egg collection. The side effects of the procedure which involves transferring your blood platelets into the ovaries under sedation may include light pain after the procedure. Very rare side effects include post-operative bleeding and fever.

What Are the Benefits of Ovarian PRP Application?The main potential benefit is pregnancy with your own eggs even after menopause! Every woman's response is different and PRP application may not work for some women. Even when it works, and menopause is reversed, it should be kept in mind that menopause is reversed for a relatively short period of time and this may or may not allow for pregnancy. While there are no guarantees, this is the latest advancement in reproductive technologies that can potentially offer a chance of pregnancy with a woman's own eggs even when her ovarian reserves are depleted. Preliminary studies and the clinical applications show very good outcomes so far, so considering the relatively low cost and very minimal side effects, a woman with depleted ovarian reserves who would like to have a chance of pregnancy with her own eggs is most certainly an ideal candidate.

How Do I Know That It Has Worked?This is very simple. If you have already entered menopause, the PRP application should restore your menstrual cycles. Numerically, you should seen an improvement in your hormone levels. Approximately 1 to 3 months after the PRP application, an increase in Anti-Mullerian Hormone levels and a subsequent decline in FSH and LH levels should be observed. These are measurable improvements that will allow you to observe the benefits of ovarian PRP application yourselves! Please keep in mind that not every woman reacts the same way to PRP application and in some cases growth factors can take up to 6 months to show their effect, therefore, tests should be scheduled to monitor progress up to 6 months. Before getting started, we will ask that you have an AMH, FSH and LH test at a local lab. Once you have received your treatment and return back home, we will ask you to repeat the same tests in 2 and 3 months time. It is important to use the same lab for your testing in order to eliminate any variations in lab measurements.

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​Below, you can view the original research publication by the Harvard scientists that had laid the foundation for ovarian cellular regeneration.